Acupuncture for postoperative gastrointestinal dysfunction in cancer: a systematic review and meta-analysis

Acupuncture is a traditional Chinese treatment modality that has been gaining scientific recognition in the management of various medical conditions. A new scientific study brought promising evidence regarding the use of acupuncture for postoperative gastrointestinal dysfunction in cancer patients, a common and debilitating complication that significantly affects patient recovery.

Postoperative gastrointestinal dysfunction is one of the most frequent and severe complications after surgery in cancer patients. This condition is characterized by a temporary suspension of coordinated bowel movements after surgery, preventing effective transport of intestinal contents and tolerance to oral feeding. The main symptoms include abdominal distension, pain, nausea, vomiting, absent bowel sounds, and inability to pass gas or stool. These manifestations not only prolong recovery but also increase the risk of additional complications, reduce quality of life, and generate higher costs for the health care system.

The researchers conducted a rigorous systematic review and meta-analysis to evaluate the efficacy and safety of acupuncture in treating this condition. The study followed international scientific protocols established by the Cochrane Handbook for Systematic Reviews of Interventions and the PRISMA guidelines. The research was registered in the international protocol database PROSPERO, ensuring transparency and adequate scientific methodology. The investigators performed a comprehensive search across eight scientific databases, including PubMed, Cochrane Library, EMBASE, and other relevant databases, covering studies published through November 2022.

The analysis included 16 randomized controlled trials, considered the gold standard in medical research, involving a total of 877 participants. Of these, 437 patients received acupuncture treatment and 440 participated in control groups. All participants had been diagnosed with cancer, undergone surgery, and developed postoperative gastrointestinal dysfunction. The cancer types included were mainly gastrointestinal tumors such as gastric and colorectal cancer, along with esophageal cancer and benign gynecological tumors.

The results demonstrated that acupuncture was significantly effective in improving the main indicators of gastrointestinal function recovery. The time to first passage of gas was reduced in a statistically significant manner compared with conventional treatment, sham acupuncture, and enhanced recovery after surgery (ERAS) protocols. Similarly, the time to first defecation also showed substantial improvement with acupuncture treatment. In addition, the time to recovery of bowel sounds, an important indicator of resumption of normal digestive function, was notably shorter in patients receiving acupuncture.

The subgroup analysis provided valuable information about different aspects of the treatment. All acupuncture techniques evaluated showed benefits, with electroacupuncture being particularly effective in reducing the time to passage of gas and defecation. Efficacy was observed across all cancer types included in the study, with especially promising results for benign gynecological tumors. Regarding combinations of acupuncture points, the study showed that both the combination of distal points and the combination of distal and proximal points were effective, the latter being especially beneficial for reducing the time to first defecation.

The acupuncture points most frequently used in the studies were ST-25, ST-36, ST-37, ST-39, PC-6, SP-6, and CV-12, located mainly on the Stomach and Spleen meridians. ST-36 was the most commonly used point, frequently combined with other distal points, possibly to avoid infection at the surgical incision site. Treatments ranged from one to two sessions daily, with needle retention of 20 to 30 minutes, started after surgery and maintained until recovery of intestinal function.

An important aspect highlighted by the researchers was the safety of the treatment. None of the included studies reported adverse events related to acupuncture, suggesting that this therapeutic modality is relatively safe for patients with postoperative gastrointestinal dysfunction associated with cancer. This finding is particularly relevant considering that these patients often present with greater frailty and susceptibility to complications.

Although the results are encouraging, the study has some important limitations that must be considered. The methodological quality of the included studies was variable, with many showing shortcomings in aspects such as adequate randomization, allocation concealment, and blinding of assessors. Most studies were conducted in China, which may limit the generalizability of the results to other populations. In addition, significant heterogeneity was observed between studies regarding acupuncture techniques, point selection, frequency, and duration of treatment.

For patients and health care professionals, these results suggest that acupuncture may be a valuable, complementary therapeutic option in the management of postoperative gastrointestinal dysfunction in cancer patients. Acupuncture offers a nonpharmacological, minimally invasive approach, characteristics that are particularly attractive in a context where patients are already exposed to multiple medical and pharmacological interventions. For clinicians, these data provide scientific evidence that may guide the incorporation of acupuncture into postoperative care protocols.

It is important to note that although acupuncture demonstrated efficacy in improving gastrointestinal symptoms, no significant reduction in hospital length of stay was observed when compared with conventional treatment and ERAS protocols. This finding suggests that although acupuncture improves intestinal function, other factors may influence the duration of hospitalization, including institutional protocols, the presence of other complications, and specific discharge criteria.

The researchers emphasize the need for future studies with higher methodological quality, involving larger and more diverse samples, different acupuncture techniques, and cancer types. They also highlight the importance of investigating optimal treatment parameters, such as frequency, duration, stimulus intensity, and ideal acupuncture point combinations. Cost-effectiveness studies would also be valuable to assess the economic impact of incorporating acupuncture into postoperative care.

In conclusion, this systematic review and meta-analysis provides robust evidence that acupuncture is an effective and safe therapeutic modality for the treatment of postoperative gastrointestinal dysfunction in cancer patients. The results suggest that acupuncture may significantly accelerate the recovery of intestinal function, improving important clinical indicators such as time to passage of gas, defecation, and return of bowel sounds. Although more high-quality research is needed to confirm